यो लेख अझै नेपालीमा अनुवाद भइसकेको छैन, त्यसैले तल अंग्रेजी संस्करण देखाइएको छ। अंग्रेजीमा पढ्नुहोस्
How does the government health insurance work?
A family of five pays Rs 3,500 a year for up to Rs 1 lakh of treatment. Outpatient care is capped at Rs 25,000 and some hospitals paused the scheme.
- शुल्क
- Rs 3,500 a year
- For a family of up to five. The government pays the premium for people below the poverty line in some districts, people over 70 and people with disabilities.
- कति समय
- फरक पर्छ
- कहाँ
- Health Insurance Board
- अन्तिम पटक जाँचिएको
- २०२६ अक्टोबर ८
- आधिकारिक पुष्टि बाँकी
यो के हो
The Health Insurance Board runs Nepal's government health insurance. A family of up to five pays Rs 3,500 a year for treatment worth up to Rs 1 lakh, at hospitals and health posts that take part in the scheme.
The scheme has been under strain. The board owed hospitals billions of rupees in 2026, and many paused services until they were paid. Outpatient care is now capped at Rs 25,000, so most of the cover is kept for hospital admissions. Check that your hospital is taking the scheme before you go.
कसलाई चाहिन्छ
- Any family in Nepal wanting cover for hospital and outpatient treatment at a low yearly cost.
के के चाहिन्छ
- आधिकारिक
A copy of each family member's citizenship or National ID
- आधिकारिक
A photo of each member
Usually taken by the enrolment assistant.
- आधिकारिक
The yearly premium
Rs 3,500 for up to five people, Rs 700 for each extra person.
प्रक्रिया
- 1
Enrol with an enrolment assistant
Enrolment assistants for the Health Insurance Board fill in a form for each family member with a copy of their citizenship or National ID, take a photo and give you an insurance card. Ask your ward or municipal health office for yours.
- 2
Show your card at a listed facility
Since July 2025 you can start treatment at any government facility on the board's first service point list, 377 public hospitals in all, instead of one pre-set facility. They refer you to bigger hospitals if needed.
- 3
Renew every year
Renew before the year ends. Renewal can be done in the board's mobile app. Only about six in ten enrolled people had active cover in 2026.
कहाँ जाने
Health Insurance Board
Kathmandu
शुल्क र समय
- आधिकारिक शुल्क
- Rs 3,500 a year
- For a family of up to five. The government pays the premium for people below the poverty line in some districts, people over 70 and people with disabilities.
| सेवा | शुल्क |
|---|---|
| Premium, family of up to five | Rs 3,500 a year |
| Each extra family memberAdds Rs 20,000 of cover | Rs 700 a year |
| Total cover per family | Rs 1 lakh a year |
| Outpatient capSince early 2026 | Rs 25,000 |
| Cover for chronic diseases | Rs 2 lakh |
प्रायः आउने समस्या
My hospital says it isn't taking health insurance.
Many hospitals paused the scheme in 2026 because the board owed them money. TU Teaching Hospital and Manmohan Hospital resumed in July 2026. Private hospitals were limited to outpatient care. Call the hospital before you go.
Why was my outpatient claim refused?
From early 2026 outpatient care is capped at Rs 25,000 for each patient or family member, down from the full Rs 1 lakh. The rest of the cover is for admissions.
Is the scheme changing?
The 2083/84 budget set aside Rs 15 billion for the scheme and plans to restructure it, aiming to cover 90% of people within three years. Rules may change, so check before renewing.
Do I pay anything at the hospital?
A 10% co-payment of treatment costs within your limit was reported from 2024. Ask the hospital what you'll pay.
What does the premium cover?
Treatment at listed facilities, including medicines, check-ups and counselling, up to the family's yearly limit.
वास्तविक अनुभव
हालै यो काम गर्नुभयो? कुन कार्यालय जानुभयो र के के मागियो, अर्को मान्छेलाई बताउनुहोस्। अनुभवहरू आधिकारिक जानकारीभन्दा छुट्टै, समुदायको टिप्पणीका रूपमा प्रकाशित हुन्छन्।
आफ्नो अनुभव सुनाउनुहोस्स्रोत
- The Kathmandu Post: TU Teaching Hospital and Manmohan Hospital resume the scheme (July 2026)kathmandupost.com
- The Kathmandu Post: private hospital services halted under the scheme (May 2026)kathmandupost.com
- The Himalayan Times: insured can use any of 377 public hospitals (July 2025)thehimalayantimes.com
- openIMIS: Health Insurance Board enrolment processopenimis.atlassian.net
- Kantipur: how to raise health insurance resources, on the 10% co-payment (2024)ekantipur.com
- Rising Nepal: outpatient insurance limit set at Rs 25,000risingnepaldaily.com
माथिका स्रोतबाट लेखिएको र अन्तिम पटक २०२६ अक्टोबर ८ मा जाँचिएको। केही विवरण अझै आधिकारिक पृष्ठसँग पुष्टि भएका छैनन्, त्यसैले जानुअघि शुल्क र कागजात कार्यालयसँगै बुझ्नुहोस्।
केही कुरा पुरानो भेट्नुभयो?सम्बन्धित